Friday, October 31, 2008

Acupuncture and IVF Meta Analisys

the study, from Guy's and St Thomas' Hospital in London, was a review
and meta-analysis of 13 randomised trials involving the use of
acupuncture during IVF treatment and outcome assessment. In total, 2500
women were included.

Further break down of the results into categories including live birth
rate, whether the control groups received no intervention at all or
sham (placebo) needle acupuncture, as well as the types of acupuncture
used, the number of sessions women were given, and who administered the
acupuncture, consistently found no significant difference.

Professor Philip Steer, BJOG Editor-in-Chief said: "Those undergoing
IVF treatment and their clinicians clearly wish for the best possible
outcome, a healthy pregnancy and birth. Over the years there has been
much back and forth regarding whether acupuncture increases the chances
of success.

"This meta-analysis appears to show that, despite its popularity,
acupuncture may have no beneficial effect on IVF after all. Further
work is required in this area to fully establish whether a link does
exist so that women can be assured that they are receiving the most
effective care."

See Abstract of the Study Below

A systematic review and meta-analysis of acupuncture on in vitro fertilisation.
El-Toukhy T, Sunkara S, Khairy M, Dyer R, Khalaf Y, Coomarasamy A
BJOG 2008; DOI: 10.1111/j.1471-0528.2008.01838.x.

Assisted Conception Unit, Guy's and St Thomas' Hospital, London, UK.

Numerous randomised studies have reported pregnancy outcome in women
who received acupuncture during their in vitro fertilisation (IVF)
treatment cycle. Objective The objective of this study was to conduct a
systematic review with meta-analysis of the trials of acupuncture
during IVF treatment on the outcomes of clinical pregnancy and live
birth rates. Search strategy Searches were conducted in MEDLINE,
EMBASE, Cochrane Library, ISI Proceedings and SCISEARCH. Selection
criteria All randomised controlled trials that evaluated the effects of
acupuncture compared with no treatment or sham acupuncture in women
undergoing IVF-intracytoplasmic sperm injection treatment were
included. Data collection and analysis Study selection, quality
appraisal and data extraction were performed independently and in
duplicate. A sensitivity analysis was conducted where the meta-analysis
was restricted to trials in which sham acupuncture was used in the
control group. Meta-regression analysis was used to explore the
association between study characteristics and pregnancy rates. Main
results Thirteen relevant trials, including a total of 2500 women
randomised to either acupuncture or control group, were identified. No
evidence of publication bias was found (Begg's test, P = 0.50). Five
trials (n = 877) evaluated IVF outcome when acupuncture was performed
around the time of transvaginal oocyte retrieval, while eight trials (n
= 1623) reported IVF outcome when acupuncture was performed around the
time of embryo transfer (ET). Meta-analysis of the five studies of
acupuncture around the time of egg collection did not show a
significant difference in clinical pregnancy (relative risks [RR] =
1.06, 95% CI 0.82-1.37, P = 0.65). Meta-analysis of the eight studies
of acupuncture around the time of ET showed no difference in the
clinical pregnancy rate (RR = 1.23, 95% CI 0.96-1.58, P = 0.1). Live
birth data were available from five of the eight studies of acupuncture
around the time of ET. Meta-analysis of these studies did not show a
significant increase in live birth rate with acupuncture (RR = 1.34,
95% CI 0.85-2.11). Using meta-regression, no significant association
between any of the studied covariates and clinical pregnancy rate was
found (P > 0.05 for all covariates). Conclusion Currently available
literature does not provide sufficient evidence that adjuvant
acupuncture improves IVF clinical pregnancy rate.

PMID: 18652588 [PubMed - as supplied by publisher]

Of course we all know that a meta analysis is a statistical execercise with great limitations, nevertheless it is clear that the initial enthusiasm for this practice in IVF needs to be reconsidered.

No comments: